Procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba / Interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba

Fundamento: el enfoque científico del bruxismo resulta, en no pocas ocasiones, incongruente y obedece en lo particular a tres aspectos pendientes para la ciencia en el siglo XXI. Primero la ausencia de esquemas diagnósticos y terapéuticos definitivos, segundo la necesidad del empleo de específicos y depurados métodos de evaluación epidemiológica y clínica. Por último la integración tangente y activa de los profesionales de las Ciencias Médicas para desarrollar en un orden secuencial documentos científicos. Objetivo: diseñar un protocolo de procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba. Métodos: se realizó una investigación de desarrollo en el período de marzo de 2019 a marzo de 2020. Se conformó el universo del grupo de trabajo por nueve estomatólogos de alta especialización y el universo de investigaciones lo integraron 41, de ellas con una subsiguiente muestra de 19 investigaciones, destacadas por sus aportes y fortalezas con relación a la integración interdisciplinaria, seleccionadas por muestreo intencional. Se estructuró el documento en tres acápites que desglosan momentos, acciones específicas y condicionantes conformes a la valoración del grupo de trabajo; a través de la técnica de consenso del grupo nominal. Resultados:se establecieron consultas de evolución periódicas, valoración por etapas y procedimientos terapéuticos. Además procedimientos clínicos interdisciplinarios, según el momento de integración médica que se precisa. Se asumió el diagnóstico integral del bruxismo desde un concepto sistémico-neurológico. Conclusiones: se diseñó un documento científico que protocoliza procedimientos clínicos interdisciplinarios para un nuevo enfoque del bruxismo desde la integración médica en Cuba (AU)

Background: the scientific approach to bruxism is, on many occasions, incongruous and obeys in particular three pending aspects for science in the 21st century. Firstly, the absence of definitive diagnostic and therapeutic schemes, secondly, the need to use specific and refined epidemiological and clinical evaluation methods. Finally, the tangent and active integration of professionals in Medical Sciences to develop scientific documents in a sequential order. Objective: to design a protocol of interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba. Methods: a development research was carried out in the period from March 2019 to March 2020. The universe of the work group was formed by nine highly specialized dentists and the universe of investigations was made up of 41 of them with a subsequent sample of 19 researches, highlighted by its contributions and strengths in relation to interdisciplinary integration, selected by intentional sampling. The document was structured into three sections that break down moments, specific actions and conditioning factors in accordance with the assessment of the working group; through the nominal group consensus technique.Results: periodic evolution consultations were established, assessment by stages and therapeutic procedures. Besides interdisciplinary clinical procedures, according to the time of medical integration that is required. It was assumed the comprehensive diagnosis of bruxism from a systemic-neurological concept. Conclusions: a scientific document was designed that protocolizes interdisciplinary clinical procedures for a new approach to bruxism from medical integration in Cuba (AU)

Bruxism in children: Use of the Functional Plane of Monaco (FPM).

BACKGROUND: Bruxism is a condition that results from hyperactivity in the central nervous system, and factors such as stress or other anxious conditions increase the frequency of episodes. When bruxism occurs at a young age, tooth wear can occur. The extent of wear can lead to the need for restorative dentistry and prosthetic treatments to restore the morphological and functional integrity of the teeth, with high costs associated with such treatments. CASE REPORT: A healthy 15-year-old boy presented to the orthodontist observation. His incisal ridges appeared thin, without mamelons, and with increased translucency. For treatment, the authors used only the Functional Plane of Monaco (FPM), a device which he had to wear 16 hours during the day. CONCLUSION: The orthodontist successfully treated an orthopaedic/orthodontic case with the FPM device.

Intervención educativa en pacientes con bruxismo y disfunción temporomandibular / Educational intervention in patients with bruxism and temporomandibular dysfunction

El presente texto expone los resultados de un estudio prospectivo, del tipo de intervención comunitaria aplicado en la Clínica Estomatológica Docente La Vigía, provincia Camagüey, con el objetivo de instrumentar una estrategia educativa en pacientes con bruxismo y disfunción temporomandibular en el período de enero de 2017 a enero de 2018. Se diseñó y aplicó una estrategia educativa según la metodología utilizada por la Maestría Nacional de Educación para la salud. Predominó el sexo femenino y las edades comprendidas entre los 24 y 29 años, así como el nivel escolar universitario. Al finalizar la intervención, el nivel de conocimientos fue evaluado de bueno en casi todos los pacientes, la apertura bucal limitada, el dolor muscular y articular aparecieron en menos de la mitad de los individuos; el nivel de satisfacción respecto a la intervención fue alto. Se concluyó que la estrategia generó un impacto positivo en los pacientes estudiados(AU)

The present text exhibits the results of a pilot study, of the type of community intervention applied in the Dentistry University Clinic La Vigía, Camagüey province, with the objective to arrange an educational strategy in patients with bruxism and temporomandibular dysfunction in the period from January, 2017 until January, 2018. It was designed and applied an educational strategy as the methodology used by the National Mastery of Education for the health. It predominated over the feminine sex and the ages understood between 24 and 29 years, as well as over the university school level. On having finished the intervention, the knowledge level was evaluated of good in almost all the patients, the limited mouth opening, the muscular pain and to articulate appeared in less than half of the individuals; the satisfaction level with regard to the intervention was high. It was concluded that the strategy generated a positive impact in the studied patients(AU)

Risk factors for bruxism

The aim of the present study was to summarize the risk factors for bruxism that were identified by a systematic search of the literature published between 2007 and 2016. Depending on the size of the odds ratios (ORs) and the lower limit of the 95% confidence intervals indicated by the reports, four risk categories were differentiated. Among others, emotional stress, consumption of tobacco, alcohol, or coffee, sleep apnea syndrome, and anxiety disorders were recognized as important factors among adults. In children and adolescents, apart from distress, behavioral abnormalities and sleep disturbances predominated. Knowledge of the identified risk factors may be useful when taking the medical history of bruxing patients. Although many of the described variables cannot be influenced by prophylactic or therapeutic means, we recommend the following patient-centered approach ("SMS therapy"): self-observation, muscle relaxation, stabilization (Michigan) splint.

Dental health of children with cerebral palsy.

Cerebral palsy (CP) is a common chronic motor disorder with associated cognitive, communicative, and seizure disorders. Children with CP have a higher risk of dental problems creating significant morbidity that can further affect their wellbeing and negatively impact their quality of life. Screening for dental disease should be part of the initial assessment of any child with CP. The objective of this article is to present an updated overview of dental health issues in children with CP and outline important preventative and practical strategies to the management of this common comorbidity. Providing adequate oral care requires adaptation of special dental skills to help families manage the ongoing health issues that may arise. As oral health is increasingly recognized as a foundation for general wellbeing, caregivers for CP patients should be considered an important component of the oral health team and must become knowledgeable and competent in home oral health practices.

Prevention and Management of Tooth Wear: The Role of Dental Technology.

Tooth wear is a multifactorial condition and the term is used to describe all types of non-carious tooth substance loss: abrasion (produced by interaction between the teeth and other substances), attrition (produced during tooth-to-tooth contact), erosion (produced by a chemical process) and abfraction (produced through abnormal occlusal loading that predisposes tooth substance to mechanical and chemical wear). Dental technology has an important role in preventing, managing and monitoring tooth wear in a variety of ways. Hard poly(methyl methacrylate) or soft ethylene-vinyl acetate splints can be prescribed to alleviate bruxism, the most common cause of attrition. Thermoformed appliances can be used for the application of products that reduce dental erosion such as fluoride gel. Patients with significant tooth surface loss may require laboratory-made restorations, as well as removable appliances with bite planes that generate inter-occlusal space to facilitate restorations, or surgical templates to provide guidance in preparing restorations for those requiring surgical crown lengthening. Dental study models and digitised models can also prove valuable in terms of monitoring the condition. This paper presents a review of the role that dental technology plays in tooth wear prevention, management and monitoring.

GABA and glutamate levels in occlusal splint-wearing males with possible bruxism.

OBJECTIVE: The inhibitory neurotransmitter γ-aminobutyric acid (GABA) plays an important role in the pathophysiology of anxiety behavioural disorders such as panic disorder and post-traumatic stress disorder and is also implicated in the manifestation of tooth-grinding and clenching behaviours generally known as bruxism. In order to test whether the stress-related behaviours of tooth-grinding and clenching share similar underlying mechanisms involving GABA and other metabolites as do anxiety-related behavioural disorders, we performed a Magnetic Resonance Spectroscopy (MRS) study for accurate, in vivo metabolite quantification in anxiety-related brain regions. DESIGN: MRS was performed in the right hippocampus and right thalamus involved in the hypothalamic-pituitary-adrenal axis system, together with a motor planning region (dorsal anterior cingulate cortex/pre-supplementary motor area) and right dorsolateral prefrontal cortex (DLPFC). Eight occlusal splint-wearing men (OCS) with possible tooth-grinding and clenching behaviours and nine male controls (CON) with no such behaviour were studied. RESULTS: Repeated-measures ANOVA showed significant Group×Region interaction for GABA+ (p = 0.001) and glutamate (Glu) (p = 0.031). Between-group post hoc ANOVA showed significantly lower levels of GABA+ (p = 0.003) and higher levels of Glu (p = 0.002) in DLPFC of OCS subjects. These GABA+ and Glu group differences remained significant (GABA+, p = 0.049; Glu, p = 0.039) after the inclusion of anxiety as a covariate. Additionally, GABA and Glu levels in the DLPFC of all subjects were negatively related (Pearson's r = -0.75, p = 0.003). CONCLUSIONS: These findings indicate that the oral behaviours of tooth-grinding and clenching, generally known as bruxism, may be associated with disturbances in brain GABAergic and glutamatergic systems.

[Contributions of medical hypnosis to orthodontic treatment]. / Apport de l'hypnose médicale aux traitements d'ODF.

Hypnosis is making a comeback in all of the medical disciplines. But in a world where everyone wants to control everything and manage everything, it's helpful to know that hypnosis is a dynamic process that cannot be forced on anyone, a psychic reality, clearly demonstrated today by brain imaging. Hypnosis does not take any power over the individual. It is just one more tool to help ease patient's discomfort. It is also useful to avoid professional burnout to provide care without depleting our energy and without wasting our valuable time. Medical hypnosis is a real asset for providing comfortable orthodontic treatment and creating a serene atmosphere. It can be done simply and rapidly to take high quality impressions, to place braces comfortably on a patient who is sitting quietly. Orthodontic treatment requires cooperation and motivation, so let's give our patients a new sense of confidence and a willingness to cooperate.

Should occlusal splints be a routine prescription for diagnosed bruxers undergoing implant therapy?

Despite the documented excellent clinical performance of dental implants, concerns linger regarding the best way to protect the restored dentition in patients with bruxism. This is because of the risk of occlusal overload that is reported to cause biological and biomechanical failures in the implant-prosthesis system. To better distribute occlusal loads to the rigid components of the prosthesis and to the interface between bone and implant during parafunctional movements, several dentists prescribe acrylic resin occlusal splints for nocturnal use by patients considered at risk. However, it is unclear whether this recommendation is based on scientific evidence or expert clinical opinion. This report reflects our effort to employ the systematic review protocol to assess whether there is scientific evidence to recommend an occlusal splint in bruxers after implant therapy.

Roles played by histamine in strenuous or prolonged masseter muscle activity in mice.

Bruxism and/or clenching, resulting in fatigue or dysfunction of masseter muscles (MM), may cause temporomandibular disorders. Functional support of the microcirculation is critical for prolonged muscle activity. Histamine is a regulator of the microcirculation and is supplied by release from its stores and/or by de novo production via the induction of histidine decarboxylase (HDC). Interleukin (IL)-1, a cytokine involved in temporomandibular disorders, is an inducer of HDC. In the present study, we examined the roles of histamine, HDC and IL-1 in MM activity. Experiments were conducted using our R+G+ model. A mouse restrained (R+) inside a narrow cylinder (front end blocked with a thin plastic strip) gnaws away (G+) the strip to escape, with the weight reduction in the strip serving as an index of MM activity. Fexofenadine (a peripherally acting histamine H1 receptor antagonist) reduced MM activity in normal mice. Both H1 receptor-deficient and HDC-deficient mice exhibited low MM activity. Prolonged R+G+ induced HDC activity in MM. Mast cell-deficient mice exhibited strikingly low HDC induction in MM (and also in the quadriceps femoris muscle) in response to muscle activity or IL-1ß. Mast cells were present around blood vessels and nerves in the epimysium and perimysium of MM. These results, together with others reported previously, suggest that: (i) peripheral histamine supports strenuous MM activity; (ii) strenuous MM activity stimulates mast cells to release histamine and to induce HDC (which replenishes the histamine pool in mast cells, possibly mediated by IL-1); and (iii) peripheral histamine H1 receptor antagonists may be effective in treating temporomandibular disorders or preventing prolonged clenching and/or bruxism.

Oral rehabilitation of severely worn dentition using an overlay for immediate re-establishment of occlusal vertical dimension.

The aim of this study was to describe the treatment used in an elderly patient presenting with bruxism and dental erosion, with good gingival health and bone support, but with decreased occlusal vertical dimension (OVD). The oral rehabilitation of elderly patients presenting with bruxism in association with tooth erosion has been a great challenge for dentists. The loss of OVD, the presence of occlusal instability and the absence of an effective anterior guide due excessive dental wear, can damage stomatognathic system (SS) biology, the function and the aesthetics. In the first treatment stage, an overlay removable partial denture (ORPD) was fabricated for the immediate re-establishment of function and aesthetics. After a 2-month follow up, with the patient presenting no symptoms, a second rehabilitation stage was accomplished, with fixed and removable prostheses. Oral rehabilitation with an ORPD was able to re-establish the SS biology, but a correct diagnosis and treatment plan are essential for success. The ORPD is a non-invasive and reversible restoring modality for general dentists that allow the re-establishment of the patient's immediate aesthetics and function at low cost.